Friday, March 19, 2021

Ready for My Annual Screening, Dr. DeMille

OK, that’s a pretty bad knock-off adaptation of a line from the 1950 motion picture, Sunset Boulevard. But it’s meant to highlight another potential killing side effect from the pandemic: avoiding normal health screenings, check-ups and testing for all those ailments that existed before COVID-19 swept the nation. Anything that might bring someone into a medical building, a doctor’s waiting room, a hospital or a medical test center. “Things medical” appear to be deeply associated with “things COVID.” All those images, online and on television, of frontline workers struggling to handle to pandemic overload. Temporary morgue trucks. Squealing ambulances. Masked nurses, medical techs and doctors. And those constant and horrible infection, hot spot and mortality statistics. 

It’s hard enough to get out into the world in general. Many businesses are closed or limited, lots of folks work from home, and hordes of selfish antivaxxers and mask-averse self-righteous COVID marginalizers just seems to underscore why going to a medical facility is just one giant unnecessary tempting of fate. The slow and often confusing vaccine rollout doesn’t help. Folks are having heart attacks, strokes and a host of serious medical issues… and simply not heading to the emergency room for obviously needed emergency attention. Even as the vaccine rollout expands, even at the spread of the virus seems to be slowing, we just crossed half a million deaths in this country. Even optimistic Joe Biden does not see real normalcy returning until the end of the year.

If there is that much reluctance in the general public to seeking appropriate medical attention for serious and even life-threatening emergencies, the desire to undergo routine testing seems to have generated even greater resistance. In some cases, hospitals have reallocated their resources to COVID, moving practitioners from other medical specialties into hardline COVID care. Writing for the February 22nd Los Angeles Times, Hayley Smith highlights the particularly sensitive arena among women, particularly in early-stage cancer detection… when cures and solutions are most effective: 

“[Women] women across Southern California are reporting appointments delayed, exams canceled and screenings postponed because of the pandemic. Some are voluntarily opting out for fear of encountering the virus, while others have had their appointments canceled by healthcare providers rerouting resources to COVID-19 patients.

“But with the outbreak in its second year, experts are sounding the alarm about the ramifications of letting women’s wellness fall by the wayside… The problem is significant. A study published by the federal Centers for Disease Control and Prevention found that during Southern California’s first stay-at-home order, cervical cancer screenings plummeted 80% among 1.5 million women in Kaiser Permanente’s regional network.

“The findings have ‘important public health implications,’ said Chun Chao, a research scientist at Kaiser Permanente Southern California. ‘Delayed or missed cancer screenings could lead to increased risk of cancer and more advanced disease when diagnosed.’

“Dr. Maureen Miller, an epidemic intelligence service officer at the CDC and one of the study’s lead authors, said cervical cancer screening rates are generally the same year over year, so the change between 2019 and 2020 marked a ‘substantial difference.’… ‘We’re not only worried about cancers, we’re worried about pre-cancers,’ Miller said. ‘You could potentially have a serious disease developing in your cervix that you might not be able to feel in your body…. It’s really important.’

“Cervical cancer was once one of the most common causes of cancer death for American women. The rate dropped significantly when routine screening became more widespread, and it is now estimated that up to 93% of cervical cancers are preventable, according to the CDC… ‘Screening is so important,’ said Dr. Ritu Salani , an OB-GYN at Ronald Reagan UCLA Medical Center in Los Angeles. ‘If we don’t catch it now, it may present at more advanced stages when it’s more challenging to treat, or more aggressive therapies might be needed, and with poorer outcomes.’

“And it’s not just cervical cancer: Mammograms, fertility treatments and even pain prevention procedures have been waylaid by the pandemic, several women said. In April, the CDC and the Centers for Medicare and Medicaid Services both published guidelines recommending the postponement of elective and non-urgent procedures, including ‘low-risk cancer’ screenings, amid the first wave of the pandemic…

“Like Pap smears and HPV tests, mammograms can be essential in reducing the number of cancer deaths. One 2020 study published in the journal Lancet Oncology projected that delays in diagnosis and treatment during the COVID-19 pandemic could result in as much as a 9.6% increase in breast cancer deaths in the U.K. over five years.

“Yet even before the pandemic, women’s wellness has often taken a back seat. Clinical trials have historically been conducted with men, and things such as seat belts, safety equipment and even office air conditioning are all designed with men’s bodies in mind. Transgender women in particular have long battled barriers to care… That women’s procedures are regularly classified as ‘elective’ can add to that burden, Salani said, noting that hospitals typically categorize admissions as ‘urgent, emergent or elective.’

“Women’s wellness ‘is neither urgent nor emergent, but it truly isn’t something that’s optional, and that’s what it makes it sound like,’ she said. ‘It’s unfortunate terminology.’” Even a simple skin cancer check-up requires a doctor visit. For women already scared of venturing into medical facilities, where resources are still available, the issue of insurance coverage, co-pays and deductibles during a time of severe financial impairment presents another massive deterrent to these preventative necessities. This is particularly true for concentrations of low-income minorities and non-citizen residents. 

If there is one potential benefit from this unequal pandemic disruptor, it is an opportunity for the United States to address universal healthcare and reverse the anomaly of being the only developed nation without such a program. We really need to stop paying double the average per capita cost of healthcare of the rest of the developed world… and if nothing else, the pandemic has placed a huge downward reality on medical costs. In short, this is a great time to solve this issue.

I’m Peter Dekom, unless and until we can solve the everyday problems of “most of us,” we will continue to watch polarization amplify and destroy our nation.


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